Vaccinations for children with impaired splenic function and children undergoing splenectomy in the United States*

Vaccine	<2 years old	2 to 10 years old	>10 years old	Revaccination (booster doses)
Pneumococcus PCV13 (Prevnar) and PPSV23 (Pneumovax)	4-dose series of PCV13 at 2, 4, 6, and 12 to 15 months of age	1 dose of PPSV23 ≥8 weeks after last dose of PCV13 (if 4-dose PCV13 series previously given)^¶		Revaccinate with PPSV23 every 5 years^Δ^◊
Haemophilus influenzae type b Hib (ActHIB, Hiberix, Pentacel^§, or PedvaxHIB)	ActHIB, Hiberix, Pentacel: 4-dose series at 2, 4, 6, and 12 to 15 months of age OR PedvaxHIB: 3-dose series at 2, 4, and 12 to 15 months of age	Recommended only if not previously vaccinated, vaccination status is unknown, or primary series is incomplete^¥ǂ		Not required
Meningococcus serotype ACWY MenACWY (Menactra, Menveo, or MenQuadfi)	4-dose series of Menveo at 2, 4, 6, and 12 months of age^†**	Menveo, Menactra, or MenQuadfi^¶¶: 2 doses ≥8 weeks apart^ΔΔ		Revaccinate at intervals based on age: Age <7 years: 3 years after completion of primary series and every 5 years thereafter Age ≥7 years: every 5 years
Meningococcus serotype B MenB-FHbp (Trumenba) or MenB-4C (Bexsero)	Not recommended until age 10		Trumenba: 3 doses at 0, 1 or 2, and 6 months OR Bexsero: 2 doses given ≥1 month apart	1 year after completing the primary series and every 2 to 3 years thereafter
Seasonal influenza^◊◊	1 dose annually for children >6 months^§§			Annually at start of influenza season

This table should be used in conjunction with the UpToDate topic on prevention of infection in patients with impaired splenic function and the individual topics on pneumococcal, meningococcal, and influenza vaccination. In addition to the vaccines above, patients with impaired splenic function should also receive all routinely recommended age-appropriate vaccines. For patients undergoing elective splenectomy, vaccinations should be given at least 14 days prior to the procedure and ideally 10 to 12 weeks prior. For patients undergoing emergency splenectomy, vaccine series should be started 14 days after splenectomy. For patients with nonsurgical asplenia or hyposplenism, vaccinations should be given as soon as impaired splenic function is recognized.

* Available vaccine formulations and recommendations may differ outside of the United States.
¶ For children aged 2 to 6, give two doses of PCV13 if the four-dose PCV series is incomplete and <3 doses have been given; if incomplete and three doses have been given, give a single dose. For children >6 years old, give a single dose of PCV13. Following receipt of the appropriate number of PCV13 doses, give PPSV23. All pneumococcal vaccine doses should be given ≥8 weeks apart.
Δ Some experts prefer to given the second dose of PPSV23 three years after the first dose of PPSV23 in patients with sickle cell disease.
◊ This recommendation differs from the Advisory Committee on Immunization Practices, which recommends a single revaccination dose of PPSV23 five years after the first PPSV23 dose.
§ Pentacel is a combination vaccine that targets diphtheria, pertussis, polio, and tetanus in addition to H. influenzae type B.
¥ For children <5 years old with anatomic or functional asplenia who are unvaccinated or who received only one dose before 12 months of age, give two doses eight weeks apart; if two or more doses were given before 12 months of age, then give one dose at least eight weeks after the last dose. For unvaccinated patients ≥5 years old, give one dose.
‡ For unvaccinated children ≥15 months undergoing an elective splenectomy, give one dose at least 14 days prior to the procedure.
† Only Menveo can be given before age 2. Menactra is not recommended for use in children <2 years old with impaired splenic function.
** If the first dose is given at ≥7 months of age, give two doses. The second dose should be given ≥12 weeks after the first AND when the child is >1 year old.
¶¶ Menactra must be administered at least four weeks after the last dose of PCV13.
ΔΔ Menactra, Mevneo, or MenQuadfi can be given at age 2 or greater. Each should be given as a two-dose series spaced at least 8 weeks apart.
◊◊ Although live attenuated vaccines can be safely given to patients with impaired splenic function who lack other immunosuppressive conditions, the inactivated influenza vaccine is preferred over the live formulation because it is equally effective.
§§ Children <9 years old who did not receive a total of two doses of influenza vaccine previously should receive two doses given ≥4 weeks apart followed by annual revaccination with a single dose thereafter.

Adapted from: Robinson CL, Bernstein H, Poehling K, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:130.

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